Reliant Care Management Company and the facilities it manages are dedicated to providing quality care in a caring and dignified manner, predominantly to both the frail geriatric population and to those with severe mental illness.

It is important to note that approximately half of Reliant’s patients have intensely chronic and complex mental, behavioral, and medical issues that include:

o Self-mutilation

o Post-Traumatic Stress Disorder

o Physically and verbally aggressive personality disorders

o Criminally violent

o Anti-social behaviors

o Suicidal tendencies

o Pyromania behaviors

o Traumatic Brain Syndrome

o Huntington’s Correa

o IV Therapy

o Severe skin disorders

Public administrators throughout the state of Missouri trust Reliant to provide secure medical and psychological care, therapy and rehabilitation for the most difficult mental health cases imaginable. We are attaching six letters of praise from these public administrators who share their own positive experiences with Reliant Care Management Company.

Reliant receives referrals from hospitals, public administrators, the courts and others who have difficulty placing persons with behavioral disorders anywhere throughout the state. An example of how well-regarded the state holds Reliant, is the fact the company has provided training for all surveyors in the state about treating patients with complex mental and behavioral issues.

Reliant receives patients who travel as far as 300 miles to its facilities for safe and quality care.

Responses to McClatchy/Kansas City Star Requests:

Question: Explain the relationship with Claire and Joe. How did that relationship begin and how did it evolve into forming Blackhawk Partners? What is the history with the Ozarks houses, and other joint property including 2 Jet Skis and a Nissan. How does that arrangement work? How do the parties use that property?

Reliant’s response: Rick DeStefane and Joseph Shepard have a long-standing and warm friendship that pre-dates Joseph meeting Senator McCaskill. Prior to Joseph meeting Senator McCaskill, Rick and Joseph jointly purchased personal residences and recreational property for their joint families’ use at the Lake of the Ozarks.

Question: In regards to campaign donations; how does Rick make those funding decisions for donating to Senator McCaskill and others?

Reliant’s response: If you review Rick’s record of campaign contributions, you will note that he has generously supported statewide, legislative and federal candidates and political action committees of various political parties throughout the years. Funding decisions are primarily based on positions and issues of importance in the healthcare sector.

Question: Respond to the following, including to specific incidents raised in inspection or police reports:

Chariton Park Care Center – Citation from 11/9/15

Reliant’s response: The Chariton Park Care Center citation was in reference to a tragic incident in which a patient took her own life. Upon state investigation, the citation was reversed, and the state found no deficiency in this case.

Reliant’s response: The Eastview Manor inspection report was in regards to a fire alarm repair that we conducted during the day. During the work on the alarm system, we conducted fire watches to ensure our patients remained safe. Once the alarm system was up and operating, we ceased the fire watches. The inspector indicated that once the alarm was up and operational, the fire watches should have continued, which we dispute.

Reliant’s response: Treating this complex, mentally ill population comes with some significant challenges that we face on a daily basis. We have extremely dedicated staff who are highly-trained in the unique circumstances of operating facilities with residents who have extreme mental and behavioral conditions. While other caregivers in the state may have taken the easy path in rejecting these patients, we believe they are worth treating and saving, and we are the one and only company who takes them.

We have a tremendous track record of success and in some cases, our patients have returned to their communities and become productive members of society.

Again, we point to the attached letters of support from public health administrators throughout the state of Missouri.

Question: Discuss staffing levels and pressure ulcers based on data available through medicare.gov. Reliant’s response: Given the severity of our patients’ medical and mental conditions, and the frequency of transfers we receive daily, there are patients who arrive in our facility with existing wounds and conditions. While we cannot speak to each of the cases individually, we can share that our medical professionals are highly trained and highly compensated for the exhaustive and dedicated care they provide our patients. We staff above the minimum levels required by the government.

We value our patient surveys and take the feedback very seriously. With respect to quality measures/resident care, Reliant has an average of 4 stars out of 5, thus underscoring the quality care Reliant provides to its patients.

Reliant Responses to Follow-up Questions

1) Question: Joe Shepard took out a letter of credit with the Sugar Creek Finance Company, using the 710 (address) Ozarks property as collateral. How does Rick feel about that?

2006 incident: A patient broke a facility window and attempted to jump. However, a facility nurse interrupted the attempt and hung onto him for a period of time until he assaulted her and she lost her grip. The state investigated and indicated the facility did its job appropriately in this case. The facility did not receive a deficiency for this incident.

Following this incident, the facility received state approval to install window protectors and invested $75,000 in the installation. Shortly after the protectors were installed, the state ordered the facility to remove the protectors, citing patient dignity and respect issues. Following the state’s orders, the facility paid $15,000 to have them removed.

The windows have protective lift stops, which only allow patients to raise the window about four inches.

November 2016 incident: This patient was classified as a Residential Care

Facility (RCF) patient, which means he was free to come and go from the facility with his guardians’ permission. Unfortunately, he broke the window stops and used a cable cord to lower himself out of the window and fell to the ground. In this instance, the overnight nurse failed to conduct visual checks of the patient during the night, which is a violation of our policy. The Center is deeply sorry for the incident and disciplinary action was taken against the staff.

March 2017 incident: During a psychotic episode, the patient ran through a closed window, and was injured. The state review found no deficiency on behalf of the center.

3) Does the company now carry liability insurance?

Response: The company was self-insured prior to 2007. Since that time, the company carries full liability insurance by an outside carrier.

4) Eastview Manor: Share an explanation for the issues that were addressed in that inspection report.

Response: Again, this relates to the sprinkler system repair explanation we shared with you earlier. To provide more context, the facility was cited because the work was taking longer than the scope of work parameters. This was due to extreme summer temperatures in the facility’s attic, which would have been hazardous to the repair technicians. (The attic temperature was 120 to 130 degrees.) That caused a delay in completing the work. We accept the citations for the delay of work and for the removal of a tag that was in the way of technicians’ ability complete their work.

Once the center was back in compliance following the sprinkler system repair, the denial of payment was reversed. As is common, a denial of payment is placed into effect until any deficiencies are remedied, and then they are reversed.

5) Provide clarification on exactly what type of administrative functions Reliant has responsibility for under the management agreement.

Response: All facilities are independently operated, though they share common ownership.

Reliant provides professional services for these facilities and is not their operator. Reliant works to support the facility’s administrator and operations, but does not oversee the operations of the facility or its administrator.

As we shared previously, Reliant cares for patients with complex behavioral and medical conditions that generally most other facilities will not accept. Notwithstanding Reliant’s consistent track record of providing quality care to patients, there have been only a handful of times over the last 27 years that practices by our staff are inconsistent with our company policies. When this occurs, Reliant has taken responsibility and implemented corrective action to ensure these remain isolated events. Reliant believes its standard of care is confirmed by the quality scores it receives from patients, their guardians, and the public administrators who place their patients in our facilities.

In the Levering case that you referenced, the patient alleged a sexual assault by a CNT. The accused CNT was not on shift during the timeframe alleged, and in fact, was out of the state for a number of days. Knowing the allegation couldn’t have happened, the facility made the incorrect decision not to report the accusation. Even though Reliant knew the allegation was not true, it still should have reported the incident and, as a result, accepted the state’s citation.